Background: Despite many strategies employed to improve hand hygiene, compliance remains low at around 50%. Two reasons have been identified for this. First, implementation strategies are rarely tailored according to assessed barriers and levers to best practice. Secondly there is a lack of explicit theoretical basis for the assessment of these barriers and levers to practice. Aim: This paper reports barriers and levers to hand hygiene and an evaluation of the use of theory in assessing barriers and levers to hand hygiene. Methods: Identification of barriers and levers occurred through interviews, questionnaires and focus groups. In each case two different question schedules were used, one based on psychological theory and the other with no explicit theoretical underpinning. Results: Although there was considerable overlap in the barriers and levers identified using the two schedules there were also marked differences. Conclusions: Identification of further barriers and levers may help us address lack of compliance with hand hygiene. Using a theoretical framework may prompt the identification of barriers that people may not ordinarily report but which have an important impact on behaviour, particularly emotion.
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